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Imperial Courage Plan (HMO) Medicare Advantage Plan H5496-016 • 2027 • Placer County, CA

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$2999.00In-network
Part B Giveback
−$85.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
Placer County, CA
Local Enrollment
16 beneficiaries in Placer County
Last update:

Imperial Courage Plan (HMO) Introduction

Imperial Courage Plan is a Medicare Advantage HMO plan offered by Imperial Health Plan of California. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $2999.00 in-network maximum out-of-pocket. CMS Plan ID H5496-016 identifies this plan.

You must live in Placer County, California to enroll in this plan. CMS reports 16 beneficiaries enrolled in this plan in Placer County. For assistance with this plan, new members can call (800)838-5914 (TTY 711).

Compare Similar Plans in Placer County

Compare this plan with the two most-enrolled HMO plans available in Placer County, California. Enrollment is based on CMS local enrollment data.

HMO plan comparison for Placer County, California
Plan Detail Imperial Courage Plan Kaiser Permanente Sr Advantage Basic Sac., Sonoma Kaiser Permanente Sr Adv Enhanced Sac., Sonoma
CMS Plan ID H5496-016-0 H0524-051-0 H0524-013-0
Local Enrollment 16 11,392 9,351
Monthly Premium $0.00 $29.00 $99.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $2,999.00 $6,000.00 $3,900.00
Part B Giveback −$85.00 reduction Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $5 copay $30 copay $15 copay
Part D Deductible Not Applicable $0.00 $0.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental Not covered $0 copay $0 copay
Vision Not covered $0 copay $0 copay
Hearing Not covered Not covered Not covered

Plan Benefits

Imperial Courage Plan has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5496-016.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5496-016-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $5 copay

Preventive and Wellness Services

Annual wellness exam
Not covered
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
Not covered
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Diagnostic tests and procedures
In-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$125 copay
Worldwide emergency care
Coming soon
Urgent care
$0 copay
Inpatient hospital care
Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$200 per day for days 21-100
Ground ambulance
In-network: $150 copay

Mental Health Services

Outpatient individual therapy
In-network: $0 copay
Outpatient group therapy
In-network: $0 copay
Inpatient psychiatric hospital care
Tier 1
$150 per day for days 1-5
$0 per day for days 6-90
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: 20% coinsurance
Occupational therapy
In-network: $10 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Durable medical equipment
In-network: 20% coinsurance
Prosthetics
In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance

Dental Services

Oral exam
Not covered
Dental x-rays
Not covered
Cleaning
Not covered
Periodontics
Not covered
Endodontics
Not covered
Restorative services
Not covered
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
Not covered

Vision Services

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
Not covered
Upgrades
Not covered

Hearing Services

Hearing exam
Not covered
Fitting/evaluation
Not covered
Prescription hearing aids
Not covered
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Imperial Courage Plan as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H5496)

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.

2027 Medicare Star Ratings for Contract H5496
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Imperial Health Plan of California

Website
Imperial Health Plan of California Plan Page
Providers
Imperial Health Plan of California Providers Page
Formulary
Imperial Health Plan of California Formulary Page
Pharmacy
Imperial Health Plan of California Pharmacy Page
New Member Health Plan Help
(800)838-5914
New Member Health Plan TTY
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Imperial Health Plan of California (official source) http://www.imperialhealthplan.com October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Compare Original Medicare & Medicare Advantage 25 May, 2025

MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.